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Maternity > Exam 2 - week 8 > Flashcards

Exam 2 - week 8 Flashcards

1
Q

What is effacement?

A

thinning of the cervix (to allow fetus to descend into vagina)-
-turtle neck analogy

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2
Q

What is dilation?

A

widening of the cervix (from the size of a straw to 10cm)

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3
Q

what are the “soft tissues” of the passageway of the mother?

A

cervix, pelvic floor muscles, and the vagina

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4
Q

What is the true pelvis?

A

the bony passageway through which the fetus
must travel. It is made up of three planes: the inlet, the
mid-pelvis (cavity), and the outlet.

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5
Q

What is the false pelvis?

A

upper/broad hip bones

-these help to support the growing uterus but don’t have a strong role in from an obstetric standpoint

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6
Q

the pelvic INLET is an oval that is slightly longer from ______ to _______

A

wider in the transverse aspect (sideways) than it is

from front to back.

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7
Q

the pelvic OUTLET is an oval that is slightly longer from ______ to _______

A

front to back (anterior to posterior)

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8
Q

where is the narrowest part of the pelvic cavity?

A

at the ischial spines

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9
Q

What are the 5 critical factors in labor (5 P’s)

A
  • Passageway (pelvis and birth canal/vagina)
  • Passenger (fetus and placenta-also amniotic fluid)
  • Power of Contractions and Pushing-mom’s pushing efforts (Can be affected by meds)
  • Position / Presentation (maternal and fetal)
  • Psychosocial Considerations and Response
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10
Q

5 additional factors that play into a woman’s labor? (5 P’s again)

A
  • Philosophy (low tech, high touch)- mother’s vs provider’s
  • Partner (support caregivers)-impact of doula
  • Patience (natural timing)-not interfering e normal process
  • Patient (preparation – education)
  • Pain management (comfort measures)
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11
Q

What is the birth passageway made up of?

A

maternal bony pelvis and the “soft parts”

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12
Q

What are 4 things that influence the birth passageway?

A
  • Size of maternal pelvis
  • Type of maternal pelvis
  • Ability of cervix to dilate (widening/opening from the size of a drinking straw to 10cm), and to efface (thinning)
  • Ability of vaginal canal, and perineum to distend
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13
Q

4 possible pelvic shapes?

A
  • gynecoid (ideal for childbirth, typical female shape)
  • android (typical male shape)
  • anthropoid (usu adequate)
  • playpelloid (not favorable)
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14
Q

What are the aspects of the birth passenger (fetus) that impact the labor process?

A

• Fetal head (size and presence of molding)
• Fetal attitude (degree of body flexion)
• Fetal lie (relationship of body parts)
• Fetal presentation (first body part out of body)
• Fetal position (relationship to maternal pelvis)
-fetal station
-fetal engagement

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15
Q

What are 2 situations where molding is more “extreme” in babies?

A
  • if mom had to push for a very long time

- if baby was posteriorly facing

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16
Q

What is molding?

A
  • Overlapping (sliding) bones – allow for molding so baby can fit through more easily
  • Allows skull to pass through narrow parts of maternal pelvis
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17
Q

what do we call the spaces between the cranial bone in a baby?

A

sutures

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18
Q

what are sutures?

A
  • spaces btwn the bones

- membranous joints uniting cranial bones (allows for molding!)

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19
Q

which head diameter is smaller–suboccipitobregmatic or occipitofrontal?

A

suboccipitobregmatic is smaller (this is ideally what we want to come out of the vagina first. Usu this happens naturally with head flexion of baby)

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20
Q

What is fetal attitude?

A

refers to the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another

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21
Q

what is the most common fetal attitude?

A

FULL FLEXION: with all joints flexed—the fetal back is rounded,
the chin is on the chest, arms crossed over chest, thighs are flexed on the abdomen, legs flexed at knees

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22
Q

Why is it bad if a baby’s “fetal attitude” isn’t full flexion?

A

-their non-flexed position can increase diameter of presenting part as it passes through pelvis, increasing difficulty of birth

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23
Q

What is fetal lie?

A

-refers to the relationship of the long axis (spine) of the fetus to the long axis (spine) of mother

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24
Q

what are the 2 primary fetal lies?

A
  • longitudinal (most common)

- transverse

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25
Q

What is a longitudinal fetal lie position?

A

-occurs when the long axis of fetus is parallel to the mother’s

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26
Q

what is a transverse fetal lie position?

A
  • occurs when the long axis of fetus is perpendicular to long axis of mother
  • THIS FETUS CANNOT BE DELIVERED VAGINALLY
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27
Q

What is fetal presentation?

A
  • refers to the body part of the fetus that enters the pelvic inlet FIRST (the “presenting” part)
  • this is the fetal part that lies over the inlet of the pelvis, or the cervical os
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28
Q

What are the 3 main fetal presentations?

A
  • cephalic (head first) - 95%
  • breech (pelvis first) - 3%
  • shoulder (scapula first) - 3%
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29
Q

what is a breech fetal presentation?

A

-occurs when the fetal buttocks or feet enter the maternal pelvis first and the fetal skull enters last

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30
Q

What is the vertex fetal presentation?

A

back of baby’s head coming first

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31
Q

what is the sinciput fetal presentation?

A

chin coming first

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32
Q

what is a brow fetal presentation?

A

brow coming out first

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33
Q

what is the fetal station?

A

relationship of fetal presenting part to maternal pelvis (presenting part moves from negative to positive station)

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34
Q

What is zero station?

A

When presenting part is at the level of ischial spines

35
Q

what is a “floating” fetal station?

A

when presenting part is above ischial spines

36
Q

what does it mean when the baby becomes “engaged”?

A

-signifies the entrance of the largest diameter of the fetal presenting part (usu fetal head) into the smallest diameter of meternal pelvis

37
Q

what is the largest diameter of the fetal head?

A

-biparietal diameter (extends from one parietal prominence to the other)

38
Q

What is meant by “fetal position”?

A
  • describes the relationship of a given point on the presenting part of the fetus to a designated point of the maternal pelvis
  • meaning: which way is the baby facing?
  • most common reference point is occipital bone (O)
39
Q

what are the 4 quadrants of the maternal pelvis?

A

right anterior, left anterior, right posterior, and

left posterior.

40
Q

what is the most common and most favorable fetal position?

A

left occiput anterior (LOA)

41
Q

what are the physiologic forces (powers) of labor

A
  • Primary force: uterine muscular contractions

- Secondary force: pushing during 2nd stage of labor

42
Q

How do we monitor and assess contractions?

A
  • frequency (refers to how often the contractions occur, measured from beg of 1 contraction to beg of NEXT contraction)
  • duration (refers to how long a contraction lasts, measured from beg of 1 contraction to end of SAME contraction)
  • intensity (refers to strength of contraction determined by manual palpation or by an internal intrauterine pressure catheter)
43
Q

what are the 3 phases of a uterine contraction?

A
  • increment (buildup of contraction)
  • acme (peak/highest intensity)
  • decrement (descent or relaxation of muscle fibers)
44
Q

What components make up the psychosocial consideration that impact labor?

A
  • Readiness: Fears, anxieties, fantasies
  • Preparation for childbirth
  • Preconceived ideas about birth
  • Factors associated with positive birth
  • Support system: Explore options
45
Q

definition of labor

A

Series of processes by which the products of conception are expelled from the mother’s body (expelled via the powers of contraction)

46
Q

What causes labor to start?

A

o Causes are largely not understood but theories exist including:
 Uterine stretching
 Hormonal influence: estrogen rises, progesterone withdrawal, possible prostaglandin activity
 Oxytocin stimulates myometrium activity
 Fetal influences

47
Q

when does labor “usually” happen?

A

between 38-42 weeks

48
Q

What is “lightening”?

A

when baby’s head begins to “settle” into pelvis. Can happen 2-3 weeks before true labor in FIRST time pregnant women

49
Q

What are common pre-labor signs (signs of approaching labor?

A

• Cervical Changes - Beginning of cervical effacement
o Lightening -when baby’s head begins to “settle” into pelvis. Can happen 2-3 weeks before true labor in FIRST time pregnant women
• Braxton-Hicks contractions -start to increase
• Backaches
• Bloody show – discharge of the mucous plug, breakage of capillaries
• Spontaneous rupture of membrane
• Diarrhea
• Spurt of energy
• Weight loss

50
Q

What is TRUE labor?

A
  • Progressive dilatation and effacement
  • Regular contractions (Increasing in frequency, duration, intensity. Intensity INCREASES with ambulation)
  • Pain usually starts in back, radiates to abdomen
  • Pain NOT relieved by ambulation or by resting
51
Q

What is FALSE (practice) labor?

A
  • Lack of cervical effacement and dilatation
  • Irregular contractions that DONT increase in frequency, duration, and intensity
  • Contractions mainly in lower abdomen and groin
  • Pain may be relieved with: Ambulation, Changes of position, resting, or hot bath or shower
52
Q

What are the 3 phases of labor?

A
  • First Stage: Effacement and Dilatation from 0-10cms
  • Second Stage (Expulsion or Pushing): Full Dilatation until Birth
  • Third Stage: Separation and Delivery of the Placenta
53
Q

What is the 1st stage of labor and how is it broken up?

A

Effacement and Dilatation from 0-10cms
• Early Labor (Latent Phase): 0 - 3cm
• Active Labor (Accelerated Phase): 4 - 7cm
• Transition Phase: 8 - 10cm
NOTE: These ranges are from text book – they are old. **According to New ACOG Guidelines - Active labor begins at 5 - 6cms!

54
Q

Describe the 1st stage/LATENT phase

A
  • Beginning cervical dilatation and EFFACEMENT
  • Fetal descent beginning
  • Cervical dilatation from 0 – 6 cms
  • 5 - 8+ hours
  • Uterine Contractions:
  • Frequency 30 - 5 minutes
  • Duration 20 - 40 seconds
  • Mild- moderate
55
Q

Nursing education for latent phase

A

 Encourage the woman and her partner to remain at home as long as possible; factors that influence latent labor include maternal fatigue, hydration, and nutrition
-this phase can take 5-8+ hours

56
Q

what emotions are common in a woman in latent phase?

A

excited, talkative, smiling

57
Q

What are the uterine contractions like in the latent phase?

A

 Frequency 30- 5 minutes
 Duration 20 - 40 seconds
 Mild- moderate

58
Q

Describe the active phase of labor

A
  • Cervical dilatation from 6 to 8 cm
  • Contractions more frequent and intense
  • Q 5-2 minutes
  • 40-60 seconds
  • Moderate to strong
  • 2 - 6+ hours
  • Appx .5 – 1 cm per hour
  • Progressive fetal descent
59
Q

What are uterine contractions like in the active phase of labor

A

 Q 5-2 minutes
 40-60 seconds
 Moderate to strong

60
Q

how long is the active phase (usually)

A

2-6+ hours

61
Q

how long is the latent phase (usually)

A

5-8+ hours

62
Q

What is the rate of cervix dilation during the active phase?

A

0.5-1cm/hour

63
Q

Typical maternal response to active phase of labor?

A
  • Increased anxiety
  • Increased discomfort
  • Possible difficulty coping
  • Possible requests for medication
64
Q

Describe the transition phase of labor

A 
•	Cervical dilatation from 8 to 10 cm
•	Total time: minutes to up to 3.5 hrs
•	Progressive fetal descent
•	Contractions more frequent and intense
	Q 1 ½ - 3 mins, 60-90 seconds, strong
•	Other characteristics
	Increased rectal pressure (women start feeling like they have to poop)
	Increased bloody show
65
Q

What are contractions like during the transition phase?

A

 Q 1 ½ - 3 mins, 60-90 seconds, strong

66
Q

What is the typical maternal response during transition?

A
  • Withdrawn into self
  • Fatigue / Restless
  • Nausea and vomiting (early transition)
  • Increased sensitivity to touch
  • Increased irritability
  • Shaking, cramping of legs
  • Loss of control (“yelling” “can’t take it” “get this over with”)
  • Helplessness
  • Fear of being alone
67
Q

what marks the beginning of second stage of labor?

A

full dilatation (10 cm)

68
Q

What is the second stage of labor?

A
  • Begins with complete dilatation (10 cm)
  • Ends with birth of baby
  • Minutes to 2+ hours
  • Contractions Q 1 ½ -3 mins, 60-90 seconds, strong
  • Increased bloody show
  • Perineal bulging
  • Positional changes of the fetus
  • Cardinal movements of labor
  • Crowning: visible head within the introitus
  • Spontaneous birth (vertex)
69
Q

how long is the second stage of labor (usually)

A

• Minutes to 2+ hours

70
Q

Typical maternal responses during second stage of labor?

A
  • Urge to push
  • Fear of tearing
  • Increased energy and control
  • Positional changes of the fetus
  • Cardinal movements of labor
  • Crowning: visible head within the introitus
  • Spontaneous birth (vertex)
71
Q

What are the cardinal movements of labor?

A
  • Descent – Continues throughout labor-
  • Engagement
  • Flexion-
  • Internal rotation
  • Extension
  • Restitution-shoulders start to turn same way head turns
  • External rotation-shoulders finish turning same way head turns
  • Expulsion
72
Q

What is the 3rd stage of labor?

A 
delivery of the placenta
-•	From birth of infant to delivery of placenta
•	Placental separation
	Signs
	Delivery of placenta
	Retained
•	Schultz and Duncan mechanisms
•	Maternal responses
73
Q

how long does the 3rd stage of labor typically last?

A

up to 30 minutes

74
Q

What are some signs of placental separation?

A

slight lengthening of umbilical cord in the vaginal canal, gush of blood, fundus rises in abdomen a little bit

75
Q

What is the 4th stage of labor

A
  • begins with completion of the expulsion of the placenta and membranes and ends w initial physiologic adjustment and stabilization of mother (1 to 4 hours after birth).
  • This stage initiates postpartum period.
76
Q

What are the 2 possible ways the placenta can present with spontaneous expulsion?

A
  1. the fetal side (shiny gray side) presenting first
    (called Schultz’s mechanism or more commonly called
    “shiny Schultz’s”) or
  2. the maternal side (red raw side) presenting first (termed Duncan’s mechanism or “dirty Duncan”).
77
Q

where “should” the fundus be in fourth stage of labor?

A

• Midline and midway between symphysis and umbilicus

78
Q

What information can you gather from a vaginal examination (cervical assessment)

A

• Fetal position
• Station of presenting part
• Membrane status
-dilatation and effacement

79
Q

Goals for mother’s V/S during labor

A

o BP below +140/90
o Pulse 60-100
o Temperature between 97.8o F and 99.6oF

80
Q

Ideally, how should membrane fluid look?

A

clear and with no odor

81
Q

2 aspects we hope for/look for when assessing a fetal heart?

A

o Rate 110-160 with average variability

o Absence of late decelerations

82
Q

What are we looking for with regard to uterine contractions during labor

A

o Not less than 2 minutes

o Adequate relaxation between contractions

83
Q

what is the frequency of maternal-fetal assessment?

A 
Low Risk
o	First Stage – Every 30 minutes
o	Second Stage – Every 15 minutes
High Risk
o	First Stage – Every 15 minutes
o	Second Stage – Every 5 minutes
84
Q

what is effleurage?

A
  • a light, stroking, superficial touch of abdomen, in rhythm with breathing during contractions.
  • Used as a relaxation and distraction technique from discomfort.

Maternity (6 decks)

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